Cigarettes, cigars, and pipe tobacco are made from dried tobacco leaves. Other substances are added for flavor. The smoke from these products is a complex mixture of harmful chemicals produced by burning tobacco and its additives.

According to the American Cancer Society, at least 70 of the chemicals in tobacco smoke are known to cause cancer, including nicotine, formaldehyde, lead, arsenic, ammonia, benzene, carbon monoxide, and others. Some of these substances also can cause heart disease, lung disease, or other serious health problems.

Vaping and E-cigarettes

The tobacco product landscape continues to evolve to include smoked, smokeless, and electronic products, such as e-cigarettes. E-cigarettes, which entered the U.S. marketplace around 2007, are designed to deliver nicotine, flavorings, and other additives via an inhaled aerosol. They are known by many different names, including “e-cigs,” “ehookahs,” “mods,” and “vape pens.”

While smoking e-cigarettes may pose fewer health risks than smoking regular tobacco cigarettes—the leading cause of preventable death in the United States—it is by no means harmless. E-cigarettes still contain nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products—which increases the risk of high blood pressure and diabetes. Many also include flavoring agents that may cause a chronic lung disease called bronchiolitis obliterans. And the aerosol that is inhaled and exhaled from e-cigarettes can potentially expose users and bystanders to other harmful substances, including heavy metals, volatile organic compounds, and ultrafine particles that can be inhaled into the lungs.

E-cigarettes also can have a significant impact on oral health. A study supported by the American Dental Association Foundation determined that vaping sweet e-cigarettes can increase the risk of dental cavities. Scientists evaluated e-cigarette aerosols and found that they have similar properties to high-sucrose, gelatinous candies and acidic drinks. Additionally, the nicotine in e-cigarettes reduces blood flow, restricting the supply of nutrients and oxygen to the soft tissues of the mouth. This can cause the gums to recede and exacerbate periodontal diseases. Reduced blood circulation also inhibits the mouth’s natural ability to fight against bacteria, which can accelerate infection, decay, and other problems. There have even been reports of e-cigarette explosions and fires in the oral cavity while vaping.

For adults, e-cigarettes may have the potential to reduce health risks for current smokers if they completely transition from cigarettes to e-cigarettes; however, most adults who vape also smoke cigarettes. According to a 2018 National Academy of Sciences, Engineering, and Medicine report, there is moderate evidence that vaping increases the frequency and intensity of cigarette smoking in the future.

Youth Vaping “Epidemic”

Many e-cigarettes come in kid-friendly flavors, and a new type of e-cigarette has become increasingly popular among young adults due to its minimal exhaled aerosol, reduced odor, and small size, making it easy to conceal. Many of these products look like a USB flash drive, with a typical cartridge, or “pod,” containing as much nicotine as a pack of 20 regular cigarettes.

The U.S. Surgeon General called the recent surge in youth vaping an “epidemic” and issued an advisory emphasizing the importance of protecting children from a lifetime of nicotine addiction and associated health risks.

Any e-cigarette use among young people is unsafe, even if they do not transition to cigarette smoking. Nicotine exposure during adolescence can harm the developing brain, which continues to develop until around age 25. Nicotine also impacts adolescents’ learning, memory, and attention, and it can increase their risk for future addiction to other drugs.

A 2019 report from the U.S. Centers for Disease Control and Prevention (CDC) indicated that overall tobacco use among youth is rising, driven by a spike in e-cigarette use. From 2017 to 2018, the CDC found no significant change in the use of combustible tobacco products by teens, but e-cigarette use increased 77.8% among high school students and 48.5% among middle school students. In 2018, there were 1.5 million more current youth e-cigarette users than in 2017, according to the CDC. Among youth, e-cigarettes are the most commonly used tobacco product, ahead of cigarettes, cigars, smokeless tobacco, hookah, and pipes. And e-cigarettes are the most commonly used product in combination with other tobacco products.

In 2018, more than 3.6 million middle and high school students nationwide said they regularly use e-cigarettes, according to the 2018 National Youth Tobacco Survey. From 2017 to 2018, the number of high schoolers who reported vaping increased 78 percent. Almost half of Massachusetts high school students reported having vaped at least once, according to the 2015 Massachusetts Youth Risk Behavior Survey.

Smokeless Tobacco Products

Smokeless tobacco products are often marketed as a healthier alternative to smoking, or a way to help quit smoking, but all tobacco products are harmful to your oral and overall health.

Smokeless tobacco goes by many names, such as chewing tobacco, spit, dip, chew, and snuff, but the two basic types of smokeless tobacco are:

Chewing tobacco: Long strands of loose leaves, plugs, or twists of tobacco

Snuff: Finely ground tobacco packaged in cans or pouches, in both dry and moist formats

Staying away from all tobacco products is the only way to avoid increasing your risk of tobacco-related health problems.

Massachusetts Legislation

Massachusetts has made great progress in reducing rates of youth cigarette smoking, but the wave of new addictive tobacco and nicotine products targeted to youths requires responding in new ways to protect young people.

In 2018, Governor Charlie Baker signed into law An Act protecting youth from the health risks of tobacco and nicotine addiction, which raised the legal age to buy tobacco products statewide from 18 to 21. Effective January 1, 2019, the new law also adds e-cigarettes to existing prohibitions on public smoking, and it prohibits the use of tobacco products on the grounds of any primary, secondary, or vocational school. Additionally, the law prohibits the sale of tobacco products by any pharmacy that offers health care services. California, Hawaii, Maine, New Jersey, and Oregon have enacted similar restrictions.

The Massachusetts Dental Society (MDS) advocated for this legislation to help lower smoking rates among youth and reduce serious oral health consequences. The MDS partnered with fellow members of the Tobacco Free Mass Coalition to advance this legislation, which passed the Massachusetts House and Senate by large margins. Reducing tobacco use is a priority issue for the MDS due to the oral health complications caused by smoking and tobacco products.

Help with Quitting

Once you start smoking or using tobacco products, the addictive quality of nicotine—found in traditional cigarettes, e-cigarettes, cigars, and chewing tobacco—can make quitting especially difficult. Talk to your dentist or doctor for resources on quitting, including:

1-800-QUIT-NOW: A free, phone-based service from the U.S. Department of Health and Human Services that offers coaches, a quit plan, and referrals to local resources to help you quit tobacco use.

SmokefreeTeen: A website that provides information and assistance to help teens quit smoking and stay tobacco-free, including SmokefreeTXT—a mobile service that provides encouragement, advice, and tips to help young adults quit smoking.

For more inspiration to quit, check out the Tips From Former Smokers® campaign from the Centers for Disease Control and Prevention. Watch TV ads and get to know the real people who appear in them. You can also watch videos to hear how smoking has affected their lives.